Factors Associated with Stillbirth Autopsy Rates in Georgia and Utah, 2010-2014: The Importance of Delivery Location Open Access

Abstract

OBJECTIVE: To determine whether demographic, operational, and medical factors are associated with the performance of stillbirth autopsies in Georgia and Utah

METHODS: Using Georgia and Utah fetal death certificates from 2010-2014, we evaluated the relationship between demographic, operational, and medical factors and stillbirth autopsy performance. Analysis was conducted using logistic regression with a predicted margins approach. Each state was analyzed separately.

RESULTS: The stillbirth autopsy rate was low in both states, at 11.9% in Georgia (N = 5,610) and 23.9% in Utah (N = 1,425). In Utah, the autopsy rate significantly decreased during the study period (p = 0.01). Stillbirths delivered outside of large metropolitan areas were less likely to receive an autopsy (medium/small metropolitans: prevalence ratioGA [PR] = 0.57, 95% confidence interval [CI]: 0.48, 0.68 and PRUT = 0.48, CI: 0.38, 0.59; nonmetropolitans: PRGA = 0.57, CI: 0.43, 0.75 and PRUT = 0.37, CI: 0.21, 0.63). In Georgia, autopsies were less common among stillbirths of Hispanic women than those of white women (PR = 0.57, CI: 0.41, 0.79), of earlier than later gestational ages (PR = 0.59, CI: 0.51, 0.69) and of multiple birth pregnancies (PR = 0.71, CI: 0.53, 0.96).

CONCLUSION: Despite strong evidence supporting the value of stillbirth autopsies, the autopsy rates were low in Georgia and Utah. Stillbirths delivered outside of large metropolitan areas may be particularly underserved. Additional research is needed to determine whether autopsies were not performed because they were not offered or because parental consent was not given.

Table of Contents

Stillbirth Autopsies in the United States: A Review......1

References......8

Factors Associated with Stillbirth Autopsy Rates in Georgia and Utah, 2010-2014: The Importance of Delivery Location......13

Abstract......13

Introduction......13

Methods......15

Results......18

Discussion......21

References......26

Tables......30

Figures......36

Future Directions in Stillbirth Autopsy Research......38

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	stillbirth autopsy perinatal pathology fetal death vital records fetal death certificate
Committee Chair / Thesis Advisor	Christiansen-Lindquist, Lauren , Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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